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Ontario Neurotrauma Foundation

Guideline For Concussion/Mild Traumatic Brain Injury & Prolonged Symptoms

3rd Edition, for Adults over 18 years of age



Concussion/mTBI denotes the acute neurophysiological event related to blunt impact or other mechanical energy applied to the head, neck or body (with transmitting forces to the brain), such as from sudden acceleration, deceleration or rotational forces. Concussion can be sustained from a motor vehicle crash, sport or recreational injury, falls, workplace injury, assault or incident in the community. Clinical signs of concussion immediately following the injury include any of the following:

  1. Any period of loss of or a decreased level of consciousness less than 30 min.
  2. Any lack of memory for events immediately before or after the injury (post-traumatic amnesia) less than 24 hours.
  3. Any alteration in mental state at the time of the injury (e.g., confusion, disorientation, slowed thinking, alteration of consciousness/mental state).
  4. Physical Symptoms (e.g., vestibular, headache, weakness, loss of balance, change in vision, auditory sensitivity, dizziness).
  5. Note: No evidence of Intracranial lesion on standard imaging (if present, suggestive of more severe brain injury)

Concussion is a traumatic brain injury at the beginning of the brain injury spectrum ranging from mild to severe brain injury. Mild TBI is among the most common neurological conditions with an estimated annual incidence of 500/100,000 in the United States.6 One Canadian study examining both hospital-treated cases as well as those presenting to a family physician calculated the incidence of mTBI in Ontario to lie between 493/100,000 and 653/100,000, depending on whether diagnosis was made by primary care physicians or a secondary reviewer.7

Clinical symptoms most commonly experience following concussion are listed in Table A.

Healthcare Professional:

A person who is a member of a regulated college. Recommended experience/training of healthcare professionals treating patients for concussion symptoms should include:

  • Has had training involving direct patient care/contact and knowledge of traumatic brain injury and its biopsychosocial effects;
  • Has experience in concussion management with a high volume of patients with concussion annually; practices according to the most up-to-date, evidence-based guidelines;
  • Practices within their college defined scope of practice and recognizes when to refer to other healthcare providers as patient symptoms require.

Persistent Symptoms:

A variety of physical, cognitive, emotional and behavioural symptoms that may endure for weeks or months following a concussion.

Primary care provider (PCP):

A physician or nurse practitioner who sees people who have common medical problems and can provide comprehensive management of a health issue. This person provides continuing care to patients and coordinates referrals to other healthcare practitioners.